1. LARYNGOTRACHEAL
TRAUMA
DEPT OF OTORHINOLARYNGOLOGY
JJM M C
DAVANAGERE

2. EPIDEMIOLOGY
• Penetrating injuries knife,
gunshot, wires
• Blunt injuries high velocity
 low velocity
Blunt injuries are due to
1. Automotive accidents
2. Blow or kick on the neck
3. Strangulation

3. CLASSIFICATION
Can be classified as
1. Supraglottic
2. Glottic
3. Subglottic
4. Mixed
OR
1. Skeleton
2. Soft tissue

4. PATHOLOGY
• Pathological changes that may be
seen in laryngotracheal trauma vary
from slight bruises externally or
laceration of laryngeal mucosa
internally to comminuted fracture of
laryngeal framework
• Laryngeal fractures are common
after 40 years of age because of
calcification of laryngeal framework

5. PATHOLOGY
• Other pathological changes
include
 Haematoma
 Edema
 Subcutaneous emphysema
 Joint dislocations
cricoarytenoid, cricothyroid
( may cause RLN palsy), arytenoid
avulsions

6. PATHOLOGY
 Fracture of hyoid
 Fracture of thyroid cartilage
vertical or transverse
 Fracture of cricoid
 Fracture of upper tracheal rings
 Laryngotracheal separation

7. CLINICAL FEATURES-
SYMPTOMS
• Respiratory distress
• Hoarseness or aphonia
• Painful and difficulty to
swallow with aspiration of
food
• Haemoptysis (mucosal
tear)

8. CLINICAL FEATURES-
SIGNS
• Bruises  abrasion of skin
• Tenderness
• Surgical emphysema
• Deformed contour of laryngeal
framework
• Fracture displacement thyroid,
hyoid and other cartilages
• Laryngotracheal separation
• Granulations over injured cartilages

9. DIAGNOSIS
• IDL examination
• Direct laryngoscopy /
fibreoptic laryngoscopy
• X-ray
• CT scan
• Associated injuries

10. TREATMENT-
CONSERVATIVE
• Hospitalization
• Voice rest
• Humidification
• Steroids
• antibiotics

11. TREATMENT-
SURGICAL
• TRACHEOSTOMY endotracheal
intubation is difficult and may be
hazardous
• Open reduction it is done 3-5 days
after injury and if possible should not
be delayed beyond 10 days
• Fractures of hyoid, thyroid, cricoid are
repaired by wiring, miniplates of
titanium are used to immobilize
cartilagenous fragments

13. TREATMENT-
SURGICAL
• Mucosal lacerations are repaired by catgut
• Epiglottis anchored to normal position or even
can be excised if severely injured
• Arytenoids repositioned in their normal
position or may be removed if completely
avulsed
• In laryngotracheal separation end to end
anastomosis can be done
• Internal splintage of laryngeal structures
using laryngeal stent or silicone tube
• Webbing of anterior commissure prevented by
a silastic keel

14. COMPLICATIONS
• Laryngeal stenosis
• Perichondritis
• Vocal cord paralysis